We are pleased to share our interview with Dr. Zack Berger, author of “Talking to Your Doctor: A Patient’s Guide to Communication in the Exam Room and Beyond”. Intake.Me’s very own Stephanie Gampper interviewed Dr. Berger this past week in preparation for our upcoming Empowered Patient Chat where Dr. Berger will be our special guest. Mark your calendar: the chat is Wednesday, June 25 at a special time 6pm PST/ 9pm EST.
Intake.Me: Dr. Berger, please tell us a little bit about yourself.
Dr. Berger: I began medical school in 1998, combined with a PhD, and finished training in 2009. Now I am an Assistant Professor of Internal Medicine at Johns Hopkins in Baltimore, Maryland. My research started with rigorous training in epidemiology, and then I started connecting it to evidence based medicine. I started developing an interest in gaps of evidence and patient-doctor communication, especially how to communicate around uncertainty. I also work in bioethics.
Intake.Me: What inspired you to write this book about how patients can communicate with their doctors?
Dr. Berger: I wrote this book for three reasons. One, I discovered through research as a clinician that patients are very different, both from one person to the next as well as across geographies. However, there are universal patient needs and principles. For example, patients want to be listened to, and patients would like their preferences followed. Two, many doctors and nurses do not communicate well. Three, we have a broken health care system where we spend much more money for poorer results in the US compared to other countries. We need a systematic alignment across the system, and that includes better patient-physician communication. A patient needs to take things into their own hands when managing their health care, including communication with their doctor during a visit …”take the keys and drive the truck”. I am a big fan of “open” notes, which give a patient the opportunity to look at doctor notes. We should encourage doctors and patients to work together, and not be adversarial.
Patients come in all different shapes and sizes, and it does matter for a patient’s health how they are treated.
Intake.Me: What are some of the key themes your book explores?
Dr. Berger: There are four themes this book explores:
1) Good communication and good care is based on a good relationship. Both the doctor and the patient have to invest in the relationship.
2) Doctors and patients have to negotiate. Each comes to the visit with a certain set of expectations and needs and wants, some of which may not overlap. Neither of the parties is going to get exactly what they want.
3) This negotiation should go hand-in-hand with agenda setting and meeting in the middle. For example, a patient may have 10 items on his agenda, a doctor has 5 different items on his agenda, and 15 items cannot realistically be covered in that one visit.
4) A relationship can help bridge the gap between evidence based medicine and patient preferences.
Intake.Me: What is evidence based medicine?
Dr. Berger: Evidence based medicine is a movement that started about 35 years ago. Until that point, doctors were practicing based on medical lore and “group think”. Not many doctors were sitting down and looking at the evidence of what was working vs. not working in treatment and practice. Practice is becoming more evidence based, but we have a ways to go. For example, many doctors still give antibiotics for viral infections and order EKGs for low-risk patients without any heart condition symptoms. The challenge is that you will always have some gaps between a scientific trial and what a person wants.
Have you heard of the “Less Is More” movement? It was started by the National Physician Alliance, and they asked what primary care doctors can do to improve the health of their patients by reducing health care costs. Through a series of discussions, groups of pediatricians, family physicians, and internists each developed a list of five evidence based recommendations that if followed would get more value out of health care dollars. We as a health care system are not moving fast enough on this.
Intake.Me: It’s been almost a year since your book was published. What kind of feedback have you received?
Dr. Berger: Overall, I have received a positive response from patients, many of whom have read the book.
Patients like the book because they find it useful and have themselves experienced communication challenges when being part of this broken health care system. Primary care doctors have responded well to the book, too. I have not heard from other doctors from other specialties who may feel differently. I would like to know what orthopedic surgeons, gastroenterologists, and cardiologists think.
Intake.Me: What are your top three recommendations for patients to improve patient-physician communication?
Dr. Berger: I have four simple recommendations:
- Share your emotions and be prepared to invest in the relationship with your primary care physician.
- Set an agenda, including your top priority to be addressed during the visit.
- Be prepared to negotiate.
- Be mindful in the visit. Each person needs to pay attention to the other. Those 10 minutes in a visit can be used well or used poorly.
Intake.Me: Tell me about your new book.
Dr. Berger: The book will be called “Making Sense of Medicine: Bridging Doctors’ Guidelines and Patient Preferences” and is expected to be released in 2016.
Intake.Me: How has “patient empowerment” evolved since you started practicing medicine?
Dr. Berger: Patient empowerment is a great and valuable goal. There are plenty of empowered patients, and they are frequently empowered in other areas of life, too. These empowered patients often have more financial flexibility, a better education, and other characteristics that differ from the “average” patient seeking care. There are many disparities in health care, and while patient empowerment alone will not close these disparity gaps, it can help.